Healthcare Provider Details

I. General information

NPI: 1598122608
Provider Name (Legal Business Name): MATTHEW ZAVALA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11303 W WASHINGTON BLVD STE 200
LOS ANGELES CA
90066-6003
US

IV. Provider business mailing address

11303 W WASHINGTON BLVD STE 200
LOS ANGELES CA
90066-6003
US

V. Phone/Fax

Practice location:
  • Phone: 310-482-3223
  • Fax:
Mailing address:
  • Phone: 310-482-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW83015
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW127768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: